Zienkiewicz Adam K, Verschueren van Rees Nicolás, Homer Martin, Ong Jason J, Christensen Hannah, Hill Darryl, Looker Katharine J, Horner Paddy, Hughes Gwenda, Turner Katy M E
Department of Engineering Mathematics, University of Bristol, Bristol BS8 1UB, UK; and School of Veterinary Sciences, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK.
Department of Engineering Mathematics, University of Bristol, Bristol BS8 1UB, UK.
Sex Health. 2019 Sep;16(5):514-522. doi: 10.1071/SH18235.
Background Antimicrobial-resistant (AMR) gonorrhoea is a global public health threat. Discriminatory point-of-care tests (POCT) to detect drug sensitivity are under development, enabling individualised resistance-guided therapy.
An individual-based dynamic transmission model of gonorrhoea infection in MSM living in London has been developed, incorporating ciprofloxacin-sensitive and resistant strains. The time-dependent sexual contact network is captured by periodically restructuring active connections to reflect the transience of contacts. Different strategies to improve treatment selection were explored, including discriminatory POCT and selecting partner treatment based on either the index case or partner susceptibility. Outcomes included population prevalence of gonorrhoea and drug dose counts.
It is shown that using POCT to detect ciprofloxacin-sensitive infections could result in a large decrease in ceftriaxone doses (by 70% compared with the reference case in the simulations of this study). It also suggests that ceftriaxone use can be reduced with existing technologies, albeit to a lesser degree; either using index case sensitivity profiles to direct treatment of partners, or testing notified partners with strain discriminatory laboratory tests before treatment, reduced ceftriaxone use in our model (by 27% and 47% respectively).
POCT to detect ciprofloxacin-sensitive gonorrhoea are likely to dramatically reduce reliance on ceftriaxone, but requires the implementation of new technology. In the meantime, the proportion of unnecessary ceftriaxone treatment by testing partners before treatment could be reduced significantly. Alternatively, index case sensitivity profiles could be used to select effective treatments for partners.
背景 耐抗菌药物（AMR）淋病是全球公共卫生威胁。用于检测药物敏感性的鉴别即时检验（POCT）正在研发中，可实现个体化的耐药性指导治疗。
已建立一个基于个体的伦敦男男性行为者淋病感染动态传播模型，纳入了对环丙沙星敏感和耐药的菌株。通过定期重组活跃联系以反映接触的短暂性，捕捉随时间变化的性接触网络。探索了不同的改善治疗选择策略，包括鉴别POCT以及根据索引病例或性伴侣易感性选择性伴侣治疗。结果包括淋病的人群患病率和药物剂量计数。
结果表明，使用POCT检测对环丙沙星敏感的感染可导致头孢曲松剂量大幅减少（在本研究模拟中与参考病例相比减少70%）。这也表明，利用现有技术也可减少头孢曲松的使用，尽管程度较小；在我们的模型中，要么使用索引病例敏感性概况指导性伴侣治疗，要么在治疗前对报告的性伴侣进行菌株鉴别实验室检测，均可减少头孢曲松的使用（分别减少27%和47%）。
检测对环丙沙星敏感淋病的POCT可能会大幅减少对头孢曲松的依赖，但需要新技术的实施。与此同时，通过在治疗前检测性伴侣可显著减少不必要的头孢曲松治疗比例。或者，可使用索引病例敏感性概况为性伴侣选择有效的治疗方法。
